Download September 27 2005

MEETING OF THE BOARD OF MANAGERS
Tuesday, September 27, 2005
Board Room
University Center for Community Health
701 S. Zarzamora
San Antonio, Texas
Minutes
BOARD MEMBERS PRESENT:
James R. Adams, Vice Chair
Ira Smith, Secretary
Luis Roberto Vera, Jr., J.D
Linda Rivas
BOARD MEMBERS ABSENT:
Robert Jimenez, M.D.
Robert Engberg
Alexander E. Briseño
OTHERS PRESENT:
George B. Hernandez, Jr., President/Chief Executive Officer, University Health System
Chris Bracken, Professor & Interim Chairman, Department of Anesthesiology, UTHSCSA
Linda Boyer-Owens, Vice President, People & Organizational Development, University Health
System
Francine Crockett, Executive Director, Purchased Resources, University Health System
Theresa DeLaHaya, Vice President, Prevention Services/University Center for Community
Health
Peggy Deming, Executive Vice President/Chief Financial Officer, University Health System
Steve Enders, Senior Vice President, Ambulatory Services, University Health System
Gabriel Martyak, M.D., Associate Dean for Clinical Affairs, Office of the Medical Dean,
UTHSCSA
Roe Garrett, Vice President/Controller, University Health System
Edward Grab, President/Chief Executive Officer, University Physicians Group
Leni Kirkman, Executive Director, Corporate Communications and Marketing, University Health
System
Tony LoBasso, Vice President, Affiliate Fiscal Administration, University Health System
Tom Mayes, M.D., Interim Dean, Office of the Medical Dean, UTHSCS
Kenneth Matthews, M.D., Professor, Department of Psychiatry, UTHSCSA
Karen McMurry, Executive Director, Legal Services & Risk Management, University Health
System
Regular Meeting of the Board of Managers
Tuesday, September 27, 2005
Page 2 of 8
Pam Otto, M.D., Associate Professor, Department of Radiology, UTHSCSA; and Vice President,
Medical/Dental Staff, University Health System
Thomas Peters, Vice President, Security & Support Operations, University Health System
Bill Phillips, Director, Operational Services/Information Services, University Health System
Nancy Ray, R.N., M.A., Associate Administrator/Chief Nursing Officer, University Hospital
Richard Rodriguez, Assistant Administrator, University Hospital
Greg Rufe, Administrator, University Hospital
Theresa Scepanski, Senior Executive Director, Health System Administration, University Health
System
Jean Setzer, Ph.D., Vice President, Strategic Planning, Health Policy Research, and Grants
And other attendees.
MEMBERS OF THE PRESS:
None.
CALL TO ORDER:
Mr. Adams called the meeting to order at 6:00 p.m.
INVOCATION AND PLEDGE OF ALLEGIANCE:
Brother Cletus led the invocation and Mr. Adams led the pledge of allegiance
SPECIAL RECOGNITION:
The Honorable Sergio “Chico” Rodriguez, Bexar County Commissioner, Precinct 1 administered
an Oath of Office to Ms. Linda Rivas for her appointment to the Board of Managers for the
period September 1, 2005 through August 31, 2007.
REPORT FROM THE NOMINATING COMMITTEE AND ELECTION OF BOARD OF
MANAGERS OFFICERS – JIM ADAMS
SUMMARY:
The Nominating Committee appointed by Dr. Jimenez comprised
of Luis Vera, Alex Briseño, and Jim Adams solicited input from
the Board of Managers on September 1 for consideration in their
deliberations regarding officer position appointments for the
2005-2006 term. The Committee convened on September 21, and
recommends the following slate of officers for this term:
Dr. Jimenez – Chairman
Mr. Jim Adams – Vice Chairman
Mr. Ira Smith - Secretary
RECOMMENDATION:
ACTION:
EVALUATION:
FOLLOW-UP:
Mr. Adams recommended approval of the Nominating
Committee’s recommendation.
A MOTION for approval of this recommendation was made by
Mr. Vera, SECONDED by Ms. Rivas, and PASSED
UNANIMOUSLY.
None.
None.
Regular Meeting of the Board of Managers
Tuesday, September 27, 2005
Page 3 of 8
CITIZEN PARTICIPATION:
Mr. Faris Hodge addressed the Board of Managers regarding several issues, including matters
related to the Board of Managers, Human Resource issues, pharmacy services, cafeteria prices,
environmental issues at the University Health Center Downtown, and other issues at University
Center for Community Health.
Mr. Adams thanked Mr. Hodge for his input and directed Mr. Hernandez to reply in writing to
Mr. Hodge’s concerns.
Ms. Pat Pfeiffer of San Antonio Transcription addressed the Board of Managers regarding a
medical records transcription contract award to Cymed Transcription Services, pending Board
approval this evening. Her company is a small, woman owned business which employs 14
women in San Antonio. Ms. Pfeiffer informed the Board that according to her research, Cymed
Transcription Services outsources its work to the Philippines, and noted that the UHS contract
specifications state that the company awarded the contract will conduct this specific business
inside the United States. Ms. Pfeiffer’s assessment of the situation is that the work by Cymed
must be leaving the U.S. where it can be done as economically as 2-3 cents per line, or $417, 600
for two years. San Antonio Transcription’s bid was at $502,120, with a 3% discount if paid
within 10 days.
Staff was asked to address the Board in response to Ms. Pfeiffer’s allegations. Ms. Crockett
replied that the cost difference between the low recommended bidder (Cymed) and San Antonio
Transcription is $83,520. University Health System is satisfied with the quality and level of
transcription performed by the incumbent San Antonio Transcription, the recommendation to
award to Cymed is based solely upon low bid and potential cost savings to the Health System.
Specifications within the contract do state that transcription of all reports for the University
Health System must be done within the continental United States and the recommended company
has agreed to honor the specifications. Additionally, Information Services staff has verified the
compatibility of software used and Cymed does use Soft Med.
Mr. Vera asked staff about the ranking process in determining best value to the community as
related to local companies who do not place the lowest bid. Mr. Vera believes that the Board of
Managers set a precedent earlier in the year that local firms would be given higher consideration
after a similar incident involving Frost Bank.
Mr. Hernández emphasized that although the Board’s purchasing policy is to procure goods and
services from Bexar County vendors when price, performance and quality factors are equal, this
particular contract award is being recommend based solely on low bid status, another important
aspect of the purchasing policy. The current policy is based on the City and County Purchasing
Acts but is not law, and can be amended by the Board of Managers if it so desires.
The Board members present discussed the need to reconvene an ad hoc committee of the Board
for the purpose of reviewing the purchasing policy to comply with actual Board practices.
(At this time a MOTION to TABLE the low bid recommendation for a Contract with Cymed
(#2507385-IF) was made by Mr. Vera, SECONDED by Mr. Smith, and PASSED
UNANIMOUSLY, until the Board has an opportunity review the purchasing policy.)
Regular Meeting of the Board of Managers
Tuesday, September 27, 2005
Page 4 of 8
APPROVAL OF MINUTES OF PREVIOUS MEETING:
SUMMARY:
RECOMMENDATION:
ACTION:
EVALUATION:
FOLLOW-UP:
The minutes of the special Board meeting of August 16, 2005
were presented for approval.
Mr. Adams recommended approval of the minutes as submitted.
A MOTION for approval of the minutes was made by Mr.
Smith, SECONDED by Ms. Rivas, and PASSED
UNANIMOUSLY.
None.
None.
REPORT FROM THE PRESIDENT OF THE HEALTH SCIENCE CENTER –
FRANCISCO CIGARROA, M.D.
SUMMARY:
RECOMMENDATION:
ACTION:
EVALUATION:
FOLLOW-UP:
Upon Dr. Cigarroa’s arrival he was asked to report on HSC
matters. He stated that it has been a privilege to work with
University Health System and is amazed at how well staff has
worked with medical students, side by side, providing care to
Louisiana evacuees. The Health Science Center is seeking
department status for the Neurosurgery program due to the
recruitments and support received from the University Health
System. The application has received approval by the Board of
Regents and is pending review by the Texas Higher Education
Coordinating Board. Dr. Mayes agreed that the hurricane relief
experience has made a very powerful statement to the medical
students and will impact the rest of their careers. He welcomed
Ms. Linda Rivas and offered his assistance. He acknowledged
faculty members present, and provided a status report on the
Medical Dean search, as requested by Mr. Smith.
A
recommendation for finalists has been made to Dr. Cigarroa.
Additional and more extensive interviews are scheduled for the
month of October. The University Health System has been part
of this process as well. Mr. Adams thanked Dr. Cigarroa for his
leadership and in arranging Mr. Hernandez’s presence at an
upcoming Board of Regents meeting for information sharing
purposes.
None.
This report was provided for informational purposes only, and no
action was required by the Board of Managers.
None.
None.
NEW BUSINESS
A. CONSIDERATION
OF
APPROVAL
OF
RECOMMENDATIONS
AND
ACCEPTANCE OF REPORTS IDENTIFIED AS CONSENT AGENDA ITEMS:
SUMMARY:
Five (5) action items were presented for approval on the consent
agenda:
Regular Meeting of the Board of Managers
Tuesday, September 27, 2005
Page 5 of 8
1.
2.
3.
4.
5.
Report from the President of the Medical-Dental Staff –
David Hnatow
a.
Consideration
of
Medical-Dental
Staff
Recommendations Regarding Staff Membership
Commissioning of Peace Officers – Tom Peters
Consideration of Appointments to the University Health
System Foundation Board of Directors – Jim Adams
Consideration of Changes to the Bylaws of the Board of
Managers – Ira Smith
Purchasing Activities (See Attachment A) – Francine
Crockett
Informational items:
6. Report on Supplier Diversity – Francine Crockett
7. Second Quarter Progress Report on 2005 Strategic
Priorities – George Hernandez
RECOMMENDATION:
ACTION:
EVALUATION:
FOLLOW-UP:
Mr. Adams pulled the Contract for Service with Cymed
Transcription Services (#2507385-IF) from the purchasing
agenda. He recommended approval of the remaining action
items on the consent agenda.
A MOTION for approval of the remaining action items on the
consent agenda was made by Mr. Smith, SECONDED by Ms.
Rivas, and PASSED UNANIMOUSLY.
See Citizen Participation Item No. 2 for discussion and
MOTION on transcription services contract (#2507385-IF).
Ms. Rivas will be provided with Board minutes and other
relevant data regarding the Board’s prior discussions with staff
regarding the Frost Bank contract. Staff is asked to work with
the appropriate Board standing committee to address Health
System purchasing that should take the importance of locality
into account. The Board of Managers requested a full update
regarding Supplier Diversity matters in the near future
ITEMS RELATED TO PLANNING & OPERATIONS –NONE
ITEMS RELATED TO BUDGET & FINANCE – ROBERT ENGBERG, CHAIR
1. CONSIDERATION OF SELECTED PURCHASING ACTIONS – GEORGE
HERNANDEZ
SUMMARY:
A. Contract for Rental Services with Xerox – Francine Crockett
B. Contract for Professional Services with Robert Ruiz, M.D. –
Theresa Scepanski
RECOMMENDATION:
The Strategic Financial Planning Committee recommended
approval of a 5-year contract award to Xerox Corporation; and
approval to authorize the President/CEO to execute an
Regular Meeting of the Board of Managers
Tuesday, September 27, 2005
Page 6 of 8
ACTION:
EVALUATION:
FOLLOW UP:
Agreement with Robert Ruiz, M.D., for a total estimated amount
of $150,000.
There were no objections made to staff’s recommendation for
approval of the contracts, and the contracts were approved.
Regarding the contract for rental Services with Xerox, Ms.
Crockett clarified for Ms. Rivas that the five year contract
includes the cost of maintenance and supplies, such as toner.
Mr. Smith cautioned staff that in his experience, every savings
comes with a headache. He asked staff to be vigilant regarding
personnel, material, scheduling. He noted that it is not enough
for projects to appear cost-effective, but that cost effectiveness
needs to managed and the management of an in-house copy
center will not be easy and sometimes will be frustrating.
None.
2. KATRINA REPONSE REPORT – STEVE ENDERS/TOM PETERS/GEORGE
HERNANDEZ
SUMMARY:
RECOMMENDATION:
ACTION:
Mr. Peters reviewed the initial steps which eventually led to the
University Health System’s intense involvement in relief efforts
for victims of Hurricane Katrina. A press conference by Mayor
Hardberger and Judge Wolff on September 1 called for a
commitment from local community leaders to support this effort.
Dr. Fernando Guerra and George Hernandez committed their
respective organizations for health care matters. The Health
System went into action and executed necessary steps to address
physician credentialing matters, logistics, patient management,
evacuees and special needs patients. Mr. Enders reviewed the
actions quickly taken by the Ambulatory Services division.
CMA and SAMHD volunteer physicians were recruited, as were
shelter support staff and responses to medical needs began. The
need to transition from a triage system to a primary service also
quickly became apparent. It was agreed that the Health System
would transition the Levi Strauss location to an Express Med
Operation. Challenges included information technology issues,
medications, and chronic health issues.
Mr. Hernandez reported unprecedented cooperation among
community agencies and proof of region readiness, community
resources had responded to the needs of the Louisiana evacuees.
Seventy five percent of evacuees had transitioned out of shelters
by the time Hurricane Rita arrived. The names of the volunteer
staff members and response timelines were displayed in the
Board Room. The cost of treating Hurricane Katrina evacuees
through September 18, 2005, was also provided. The University
Health System will vigorously pursue the maximum federal and
local reimbursement dollars allowed for providing these services.
None.
This report was provided for informational purposed only, and
Regular Meeting of the Board of Managers
Tuesday, September 27, 2005
Page 7 of 8
EVALUATION:
FOLLOW UP:
no action was required by the Board of Managers.
The Board of Managers thanked staff for their efficient support
of this effort and asked Mr. Hernandez to relay their appreciation
to all staff.
Management staff will explore employee recognition
opportunities for the staff involved in these efforts.
2. CONSIDERATION OF FINANCIAL/OPERATIONS REPORTS FOR AUGUST
2005 – PEGGY DEMING
SUMMARY:
In August, the Health System experienced a gain of $6.7 million
from operations which exceeded the budgeted loss of $343,000
by $7.0 million. The gain was primarily due to higher DSH/UPL
revenue. The higher DSH/UPL was a direct result of the
extensive legislative work done by the Health System and other
hospital districts during the 79th Legislative session to prevent
the roll out of Star+Plus. As a result two one time adjustments
were made by the Health and Human Services Commission for
SFY 2005. One of the adjustments was to include data associated
with Bexar County service area Primary Care Case Management
(PCCM) in the calculation of DSH and UPL for SFY 2005.
Unfortunately, the State has announced that the PCCM model in
the Bexar County service area will be converted to a capitated
HMO model effective July 1, 2006. Capitated managed care
models do not qualify for supplemental UPL payments. The
second change was to take advantage of a one time Federal
adjustment made to allow State hospitals to increase Federal
match funding up to 175% of their DSH cap. This adjustment
was extended to the large public hospitals. This Federal 175%
adjustment expired September 1, 2005 and is no longer
available. Both of these changes resulted in an increase in
DSH/UPL funds of $5.5 million in August. Additional funds
associated with these two changes are expected in September
and October but the exact amounts will not be known until the
funds are received.
Most revenue categories other than physician rental income
(which was slightly behind) exceeded budget in the month. On
the expense side, most expense categories performed worse than
budget with the exception of Purchased Services. This was
primarily due to the higher activity level (up 3.1%) experienced
during the month except for Supplies. Staff continues to work
with our physician partners on supply cost matters. Investment
income was up in the month and exceeded budget by a net
$179,000. The gain before considering market adjustments was
$7.6 million which exceeded budget by $7.2 million. A drop in
interest rates the last week of August created a $947,000
unrealized market gain which contributed to a further increase in
the Health System’s bottom line gain to $8.5 million.
RECOMMENDATION: Ms. Deming recommended acceptance of the financial reports
subject to audit.
ACTION:
A MOTION for approval of this recommendation was made by
Regular Meeting of the Board of Managers
Tuesday, September 27, 2005
Page 8 of 8
EVALUATION:
FOLLOW-UP:
Mr. Smith, SECONDED by Ms. Rivas, and PASSED
UNANIMOUSLY.
None.
Staff will provide a report that outlines prior year’s trends
regarding actual vs. estimated year end bottom line variances for
approximately a 10 year period as requested by Mr. Smith.
COMMUNICATIONS
Messrs. Vera and Hernandez announced a press conference with Carlos Ayus, M.D., and other
dialysis patients, this Wednesday at 10am at Dialysis West at University Center for Community
Health. The purpose of this event is to release findings from the UHS sponsored study on daily
dialysis recently published in the Journal of American Nephrology. Mr. Vera thanked the Board
of Managers for its vision and compassion in taking on this project. The outcome data places
Dialysis West in the Top 1% in the nation, with regard to mortality. Also, the National Institutes
of Health is beginning a trial in October that will include Dialysis West. All Board members
were invited to attend the press conference.
ADJOURNMENT:
There being no further business, Mr. Adams adjourned the meeting at 7:35 p.m.
___________________________________
Jim Adams
Vice Chairman, Board of Managers
______________________________
Ira Smith
Secretary, Board of Managers
____________________________________
Sandra D. Garcia
Recording Secretary